Provider Demographics
NPI:1902083769
Name:ACKAL, CHRISTINE ADELE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ADELE
Last Name:ACKAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 FORTUNE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5542
Mailing Address - Country:US
Mailing Address - Phone:337-298-0937
Mailing Address - Fax:337-394-5435
Practice Address - Street 1:814 FORTUNE RD STE 109
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5542
Practice Address - Country:US
Practice Address - Phone:337-298-0937
Practice Address - Fax:337-394-5435
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist